Content contained in this newsletter may have been previously published in prior issues of the QCC newsletter.

The Florida Nursing Home

Quality Care Connection

This QCC Newsletter is your monthly National Nursing Home Quality Care Collaborative (NNHQCC) in Florida member update that provides information on the latest activities. It is a quick reference for information on upcoming learning events, links to improvement tools, resources, news, best practices, and success stories.

The Centers for Medicare & Medicaid Services (CMS) recently released Interpretative Guidance update for Phase II of the Requirements of Participation. A CMS Certification and Survey Memo,
dated June 30, 2017, outlines the Revised Interpretive Guidance for Survey Agencies, revised F-Tags, a revised survey process, training resources for surveyors and Long-Term Care (LTC) providers and enforcement, and Nursing Home Compare considerations for Phase II. Phase II requirements are scheduled to take effect November 28, 2017.

Encourage Resident Mobility

On April, 27, 2016, the Centers for Medicare & Medicaid Services (CMS) added six new quality measures to its consumer-based
Nursing Home Comparewebsite (
https://www.medicare.gov/nursinghomecompare/search.html). In July 2016, CMS incorporated all of these measures, except for the antianxiety/hypnotic medication measure, into the calculation of the
Nursing Home Five-Star Quality Ratings. One of these measures, the Percentage of long-stay residents whose ability to move independently worsened (MDS-based), also referred to as the long-stay locomotion measure, evaluates the quality of nursing home care with regard to the loss of independence in locomotion among individuals who have been residents of the nursing home for more than 100 days. Loss of independence in locomotion is itself an undesirable outcome. Additionally, it increases risks of hospitalization, pressure ulcers, musculoskeletal disorders, pneumonia, circulatory problems, constipation, and reduced quality of life. Residents who have declined in independence in locomotion also require more staff time than those who are more independent. (
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/New-Measures-Technical-Specifications-DRAFT-04-05-16-.pdf)

The ADL quality measure reports the percentage of residents whose need for help with ADLs has increased when compared with the prior assessment. The seven-day look-back measure involved four late-loss ADLs: bed mobility, transferring, eating, and toileting.

When you are working with your staff members, you may want to consider the following questions.

The Centers for Medicare & Medicaid Services (CMS) has set a goal for all U.S. nursing homes participating in the National Nursing Home Quality Care Collaborative (NNHQCC) to achieve a Quality Measure Composite Score of 6 percent or less. The Composite Score includes the 13 long-stay quality measures publicly reported on Nursing Home Compare. As your partner in quality, Health Services Advisory Group (HSAG), the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Florida, is committed to helping you achieve your quality improvement goals.

Systemic Action is often the most challenging step in improving performance. After identifying root causes to an issue, it is important to implement changes or corrective action that can improve or reduce the chance of an event happening again. These actions should be tightly linked to the root causes in order to have a higher likelihood of being effective. It is vital to avoid quick fixes. The goal is to make strong changes that will result in lasting improvement. Actions can be defined in the following ways.

Weak: Actions that depend on staff to remember training or policies. These actions enhance or enforce existing processes.

Intermediate: Staff must remember to do the right thing, but these actions provide tools. These modify existing processes.

Strong: Actions that do not depend on staff to remember to do the right thing. Strong action redesign the process.

Pilot testing is one tactic nursing homes can use to test systemic change ideas. Think about testing or "piloting" changes in one area of your facility before launching something facility wide. Sometimes, changes can have unintended consequences.

This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Florida, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. FL-11SOW-C.2-08282017-01